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Frailty and Transplantation.

Leonie Exterkate1, Bendix R Slegtenhorst, Matthias Kelm

  • 11 Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2 Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. 3 Division of Transplant Surgery, Department of Surgery, Erasmus MC-University Medical Center, Rotterdam, The Netherlands. 4 Institute of Transplant Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany. 5 Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany. 6 Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan.

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Frailty significantly impacts organ transplantation outcomes by affecting patient selection and recovery. Differentiating healthy aging from frailty is crucial for better transplant care.

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Area of Science:

  • Gerontology
  • Immunology
  • Transplantation Medicine

Background:

  • Aging and immunosenescence are increasingly relevant in transplantation, affecting patient outcomes.
  • Frailty, distinct from healthy aging, affects over 15% of individuals over 65 and is projected to increase.
  • Frailty is characterized by reduced physiological reserve, increased vulnerability, and altered immune responses.

Purpose of the Study:

  • To assess the risk of frailty in transplant candidates.
  • To review the effects of frailty on post-transplant outcomes and recovery.
  • To summarize the pathophysiology of frailty and its impact on immune and metabolic functions.

Main Methods:

  • Risk assessment of frailty during transplant evaluation.
  • Review of existing literature on frailty, aging, and transplantation outcomes.
  • Summary of current knowledge on frailty's pathophysiology, immune, and metabolic consequences.

Main Results:

  • Frailty significantly influences patient selection, waitlist management, and post-transplant treatment.
  • Frail individuals exhibit increased inflammatory markers and altered immune responses compared to healthy aging adults.
  • Metabolic changes and physical limitations in frail individuals may negatively impact transplant outcomes.

Conclusions:

  • Frailty is a critical factor to consider in organ transplantation, impacting all stages from evaluation to recovery.
  • Understanding the pathophysiology of frailty is essential for improving transplant outcomes in older adults.
  • Further research is needed to develop targeted interventions for frail transplant recipients.